Correspondence (letter to the editor): Cardiovascular Comorbidities

I read the insightful review of Braun et al. (1) with interest, until I stumbled over a short sentence: “In patients with RA, statins reduce mortality by 20% (e18).” In other words, one in five deaths could be prevented or at least delayed. This number fits into the rising hype around statins since the publication of the 1994 4S study (Scandinavian Simvastatin Survival Study [2]).

Reading the literature cited in the article (e18) (3) reveals that the “20%” (to be precise, 21%) refers to the relative risk reduction (hazard ratio [HR] = 0.79). However, a brief calculation results in an absolute risk reduction of mortality of 2.7% (patients in the control group, 17.4%; patients in the statin group, 14.7%).

This results in a number needed to treat (NNT) of 37 over 4.5 years, corresponding to a number treated needlessly (NTN) of 36.

During a time of constant complaint about increasing polypharmacy, RA patients should not have to be burdened with statins as well—as would be obligated by the value of 20% cited by Braun et al. In my clinical-pharmacological lectures and presentations, I have always urged my listeners to ask and to insist, when stakeholders of all stripes offer a success rate of more than 5%.

From my point of view, it is unfair to offer the unsuspecting reader a reduction in mortality “of 20%”, when in fact only 2.7% can be identified from the literature.